Liver Flashcards
What is the histology of hepatitis?
Apoptotic bodies with changes to lobular architecture & disintegration
What is the histology of cirrhosis?
Fibrotic bands surrounding viable tissue.
What are the five most important causes of hepatitis? Stipulate whether they cause acute or chronic hepatitis and include infectious and non-infectious causes.
Acute: Hepatitis A to E virus, alcohol, drugs, autoimmune
Chronic: Congenital disease.
- Autoimmune: acute
- Drugs: acute
- Alcohol: acute
- Hereditary disease: chronic
- Viral(hepatitis A-E): acute and chronic
- Viruses (acute and chronic)
- Hep A (only acute); Hep B-E (acute and chronic)
- Drugs (acute and chronic)
- Alcohol (acute and chronic)
- Autoimmune hepatitis (chronic)
- Cryptogenic (chronic)
What are the mechanisms of transmission/infection for hepatitis A, B and C?
- A: Fecal/oral route, B&C = Blood, sexual contact
- B: Mother to child, sexual, unsterile needles, direct blood to blood contact.
- C: sexual contact, needles, mother to child
What is steatohepatitis and what causes it?
Liver inflammation and damage caused by fat deposition in the liver
Steatosis is an accumulation of fate in the liver while steatohepatitis is when this progresses to become associated with inflammation. Fatty liver disease is divided into: Alcohol-related fatty liver disease, Non-alcoholic fatty liver disease (associated with obesity, abnormal glucose tolerance and dyslipidaemia)
What are the symptoms and signs of a patient with acute viral hepatitis?
Jaundice, Dark coloured urine, RUQ pain, Nausea and vomiting, Fever and malaise, Hepatomegaly
RUQ pain/tenderness, Fatigue, Nausea and vomiting, Fever, Hepatomegaly, Dark urine & pale stools, Anorexia,
Rash
What are the five most important causes of chronic liver disease/ cirrhosis?
Alcoholic disease, Chronic hepatitis b and c infections, Drugs, Autoimmune, Primary biliary cirrhosis
Alcohol/Drugs, chronic viral hepatitis (B/C), Autoimmune hepatitis, Parasitic, Genetic
What are the signs of chronic liver disease on general examination? Explain the pathophysiology (cause) of each sign.
Hepatic encephalopathy: Complex neuropsychiatric syndrome resulting in disturbances in consciousness,
behaviour and personality which is believed to be due to raised blood ammonia.
Leukonychia: Hypoalbuminaemia. Whitening of the nail plate which is believed to be due to deposition of
melanin in liver disease.
Spider naevi:Oestrogen. Skin lesion that consists of a central arteriole with thread-like vessels that resemble
spider’s legs radiating outward. Believed to be due to increased plasma oestrogen and substance F which have been implicated in vasodilation and neovascularisation.
Ascites: Pathological accumulation of fluid in the peritoneal cavity as a result of: Increased capillary pressure, Decreased serum albumin, Increased hepatic lymph drainage, Renal sodium retention
Portosystemic vascular shunts: Blood tends to bypass the high pressure of the portal veins and return to the
heart via systemic vein collaterals.
Asterixis (hepatic flap) Brief, rhythmless flap
Jaundice: Yellowing of the skin, sclera and mucous membranes. There is a build-up of excess bilirubin which is then deposited in the skin and mucous membranes.
What is a normal liver span in cm as you would percuss it anteriorly?
6-15 cm but usually <12 cm
Explain the pathophysiology and signs of portal hypertension
Portal hypertension is the continued elevation in portal venous pressure, the signs of which are caused by blood being forced down alternative channels by the increased resistance to flow through the systemic venous system rather than through the portal system.
These include: Ascites, Hepatic encaphalophy, Splenomegaly,
Development of porto-systemic shunts (esophageal, gastric and anorectal varies and caput medusa)
• Portal hypertension is due classified according to where the pathology occurs.
− Pre-hepatic: blockage of vessels before the hepatic sinusoids
− Intra-hepatic: blockage in hepatic sinusoids
− Post-hepatic: blockage of central veins, hepatic veins or IVC
How and why is the portal vein connected to the umbilical vein and how does this explain the finding of a Caput Medusa?
- During foetal development, the unpaired umbilical vein carries oxygenated blood and nutrients from the mother to the foetus. Most of the blood enters the liver from its inferior border while the remainder is shunted to the IVC through the ductus venosus to bypass the liver and enter the foetal right atrium.
- Shortly after birth, the umbilical vein becomes obliterated and is replaced by a fibrous cord, the ligamentum teres. It extends from the umbilicus to the transverse fissure where it joins with the falciform ligament of the liver.
- Under extreme pressure, the ligamentum teres may reopen to allow the passage of passage through that vessel \ resulting caput medusa.
Consequence of decreased albumin synthesis
Oedema
Leukonychia
Consequence of decreased Vit K dependent clotting factor synthesis
Easy bleeding and bruising
Ecchymoses
Consequence of impaired ammonia metabolism
Hepatic encephalopathy
